MEDICARE: DR. JOHN F. BRENNER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	F6476	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780784223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN F. BRENNER D.O.

Provider Business Mailing Address
First Line	:	1650 W MAGNOLIA AVE
Second Line	:	SUITE 207
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4009
Country	:	US
Telephone Number	:	817-923-4200
Fax Number	:	817-923-4201

Provider Business Practice Location Address
First Line	:	1650 W MAGNOLIA AVE
Second Line	:	SUITE 207
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4009
Country	:	US
Telephone Number	:	817-923-4200
Fax Number	:	817-923-4201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	06/03/2008

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